Quality of Life in Age-Related Macular Degeneration - CNIB

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visual impairment and all but one of the SIP subscales demonstrated greater disability in patients than controls 32 . The SIP and SIPV were highly correlated but, in this study over half the participants had diabetic retinopathy and disability due to other diabetesrelated complications may well have influenced the result. 2.1.4 Visionspecific functional status (VF): These measures investigate visionrelated tasks such as reading, writing, watching TV, recognising faces or driving. They are usually correlated with standard measures of vision such as VA. However, because they do not differentiate between what is relevant and what is irrelevant to individual respondents, or what is important to QoL and what is not, they are not true QoL measures, although they are frequently referred to as such 10 12 . The impact on QoL of loss of or deteriorating near vision would be greater for someone who spent a lot of time reading and doing embroidery than for someone who preferred listening to music and swimming. VF measurement has also been shown to be influenced by general health 17 . For example, the ability to prepare a meal may be affected by arthritis as well as by vision and, if the questionnaire does not specifically ask the respondent to consider only the effects of their vision on a task, comorbidity may confound the scores and make results difficult to interpret. The Activities of Daily Vision Scale (ADVS) 33 was found to discriminate between mild and severe MD (overall score, near vision, daytime driving and glare) but not between mild and moderate MD 29 . The VF14 34 , originally designed for use with cataract patients correlated more highly with patients’ global assessments of their vision than did VA in a Canadian study of 159 MD patients 18 but MD severity did not predict VF14 scores. Since the VF14 scores and patients’ global assessments of their vision are both effectively 10
selfreports of vision function, it is not surprising that they correlated with each other better than with a more objective measure of VA or a measure of MD severity based on clinical features of the eye. A Finnish study 35 reported similar properties for the VF14. A visual function measure designed for use with MD and cataract patients is the Daily Living Tasks Dependent on Vision (DLTV) questionnaire 36 . It was found to correlate more strongly with distance VA in the better eye than in the worse eye. The 3 measures discussed above (ADVS, VF14, and DLTV) investigate only visual function and do not include items relating to social or psychological functioning. The Low Vision Quality of Life questionnaire (LVQOL) 37 was designed for the evaluation of low vision rehabilitation and does include a 3 item subscale relating to adjustment. In a sample of 278 patients and 70 matched controls, the measure differentiated between people with normal vision and people with low vision. LVQOL scores improved by an average of 17% following rehabilitation, compared with people with normal vision, with reading and fine work subscales most improved, but psychological adjustment and other subscales also showed improvement 37 . The NEIVFQ 38 , which has been well validated in the MD population also investigates psychological aspects of visual impairment. As well as items pertaining strictly to function, the NEIVFQ investigates social functioning, mental health and dependency. It differentiates between different eye conditions and overall score and relevant subscale scores are correlated with VA 38 . It has been shown to be responsive to change in VA over time 39 , but this was in a large study over a long period of time and the minimum change in VA investigated was 3 lines of vision. A 3 line vision loss has been used as the primary outcome measure in clinical trials for treatments for MD (e.g. 40 ). Two lines has also been recommended as 11
Page 1 and 2: Quality of life in agerelated mac
Page 3 and 4: Psychosocial interventions, includi
Page 5 and 6: Quality of life in agerelated mac
Page 7 and 8: “Quality of life is how good or b
Page 9: mistakenly concluded that MD has no
Page 13 and 14: distance VA score the patient is be
Page 15 and 16: The method of administration is a f
Page 17 and 18: health state for the rest of their
Page 19 and 20: 3. Impact of MD 3.1 Psychological w
Page 21 and 22: 20% at the time of the survey, was
Page 23 and 24: Index - wellbeing) 88 social supp
Page 25 and 26: cause of the greater distress. In c
Page 27 and 28: and a consequent fractured hip whic
Page 29 and 30: People with MD may not understand t
Page 31 and 32: adaptation. The intervention group
Page 33 and 34: VFQ) compared with controls (especi
Page 35 and 36: Distribution of aids was irregular
Page 37 and 38: acquired using TTO, were obtained b
Page 39 and 40: Several of these trials show promis
Page 41 and 42: With new treatments being developed
Page 43 and 44: accounts of their own experiences a
Page 45 and 46: the planning of rehabilitation prog
Page 47 and 48: o continuing evaluation of the impa
Page 49 and 50: 11. Bradley C. Importance of differ
Page 51 and 52: 37. Wolffsohn JS, Cochrane AL. Desi
Page 53 and 54: 65. McNair DM, Lorr M, Droppleman L
Page 55 and 56: 92. Royal College of Ophthalmologis
Page 57 and 58: 122. Scanlan JM, Cuddeford JE. Low
Page 59: 147. Culham LE, Chabra A, Rubin GS.
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Appendix 1. Patient reported outcom
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Appendix 1. Patient reported outcom
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Quality of Life in Age-Related Macular Degeneration - CNIB

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